Provider Demographics
NPI:1558557652
Name:OETKEN, JERIDY D (MBA/MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JERIDY
Middle Name:D
Last Name:OETKEN
Suffix:
Gender:F
Credentials:MBA/MS, CCC-SLP
Other - Prefix:
Other - First Name:JERIDY
Other - Middle Name:
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 SAINT MARYS RD FL 2
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4139
Mailing Address - Country:US
Mailing Address - Phone:785-762-3350
Mailing Address - Fax:
Practice Address - Street 1:1102 SAINT MARYS RD FL 2
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4139
Practice Address - Country:US
Practice Address - Phone:785-762-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist